Test Code HMSOR
Heavy Metal Occupational Exposure, with Reflex, Urine

Specimen Required

Patient Preparation:

-Patient should not eat seafood for a 48-hour period prior to
start of collection.

-High concentrations of gadolinium and iodine are known to
interfere with most metals tests. If either gadolinium- or
iodine-containing contrast media has been administered, a specimen
should not be collected for 96 hours.

Interpretation

Arsenic:

Normally, humans consume 5 to 25 mcg of arsenic each day as part
of their normal diet; therefore, normal urine arsenic output is
below 35 mcg arsenic per gram creatinine (<35 mcg/g). When
exposed to inorganic arsenic, the urine output may be more than
1,000 mcg/g and remain elevated for weeks. After a seafood meal
(seafood contains a nontoxic, organic form of arsenic), on the
other hand, the urine output of arsenic may be above 200 mcg/g,
after which it will decline to below 35 mcg/g over a period of 1 to
2 days.

Exposure to inorganic arsenic, the toxic form of arsenic, causes
prolonged excretion of arsenic in the urine for many days. Urine
excretion rates above 1,000 mcg/g indicates significant exposure.
The highest value observed at Mayo Clinic was 450,000 mcg/L in a
patient with severe symptoms of gastrointestinal distress, shallow
breathing with classic "garlic breath," intermittent seizure
activity, cardiac arrhythmias, and later onset of peripheral
neuropathy.